雄激素受体在不同分子分型乳腺癌中的表达及其与预后的关系

Expression of androgen receptor in different molecular types of breast cancer and its relationship with prognosis

目的探讨不同分子分型乳腺癌组织中雄激素受体(AR)的表达及其与多种临床病理参数、相关蛋白标志物及预后的关系。方法选取该院2011年1月至2014年12月经病理确诊为乳腺癌的患者393例,通过免疫组织化学(IHC)法检测肿瘤组织AR表达水平,分析AR表达水平与不同临床病理参数及预后的相关性。结果在393例乳腺癌组织中,AR阳性表达率为72.52%;AR表达与组织学分级、淋巴结状况相关,与AR阴性肿瘤比较,AR阳性表达肿瘤多表现为较低(Ⅰ/Ⅱ)的组织学分级(P<0.001)和淋巴结阴性(P=0.003);AR表达与雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)水平及Ki-67指数相关,与AR阴性肿瘤比较,AR阳性肿瘤多表现为ER阳性(P<0.001)、PR阳性(P=0.013)、HER-2阳性(P<0.001)及Ki-67<14%(P=0.033);AR阳性表达多见于Luminal A型(61.40%)、Luminal B型(14.38%),少见于三阴性乳腺癌(TNBC,6.67%,P<0.001)。在全部乳腺癌患者中,AR阳性患者无病生存期(DFS)较长,预后较好(P<0.001)。多因素Cox回归分析显示AR表达(HR=0.306,P<0.001)、HER-2(HR=1.646,P=0.043)、TNBC分型(HR=1.610,P<0.001)是乳腺癌复发和预后独立影响因素;AR阳性TNBC患者DFS较长,预后较好(P=0.036)。结论AR表达与多种临床病理因素、蛋白标志物及分子分型存在相关性,AR阳性表达关联较好的预后。

Objective To investigate the expression level of androgen receptor(AR)in different molecular types of breast cancer tssues and its relationship with multiple pathological parameters,related proteins markers and prognosis.Methods A total of 393 patients with pathologically diagnosed breast cancers in this hospital from January 2011 to December 2014 were selected.The AR expression level was tested by immunohistochemistry(IHC),and its correlation with different clinicopathological parameters and prognosis was analyzed.Results Among 393 cases of breast cancer tissues,the AR positive expression rate was 72.52%;the AR expression was correlated with histological grade and lymph node status.Compared with the AR-negative tumors,the AR positive expression tumors mainly manifested by the lower histilogical grade(Ⅰ/Ⅱ,P<0.001)and lymph node negative(P=0.003);the AR expression was correlated with the ER,PR and HER-2 levels and Ki-67 index,compared with the AR negative tumors,the AR-positive tumors were more expressed by ER positive(P<0.001),PR positive(P=0.013),HER 2 negative(P<0.001),and Ki-67<14%(P=0.033);the AR positive expression was more common in the luminal A type(61.40%),luminal B type(14.38%)and was rare in triple negative breast cancer(TNBC,6.67%,P<0.001);among all patients with breast cancer,the patients with AR positive had longer disease free survival(DFS)with good prognosis(P<0.001);the multivariate Cox regression analysis showed that the AR expression(HR=0.306,P<0.001),HER2expression(HR=1.646,P=0.043)and TNBC classification(HR=1.610,P<0.001)were the independent factors of recurrence and prognosis in the patients with breast cancer;the AR positve patients with TNBC had longer DFS and better prognosis.Conclusion The AR expression has the correlation with multiple clinicopathological factors,protein markers and molecular types.The AR positive expression is associated with better prognosis.